The circumstances of the incident

The circumstances of the incident The circumstances of the incident The incident took place on Ward X during an early shift. During this shift, there were 30 patients on the ward, in four six bedded bays and six side rooms. During the early shift, Mrs J was seen on the ward round and was discharged by the medical team. Mrs J had had a laparascopic cholecystectomy five days previously, but had developed pneumonia in the postoperative period and therefore had been on the ward much longer than had been anticipated. Mrs J was a 58 year old semi-retired librarian with a history of hypertension treated with antihypertensive medication. During this morning shift, the staff nurse, Nurse M, looking after all the patients in Mrs Js bay, was asked to discharge Mrs J by the medical team, and Mrs J was very relieved, and called her daughter and son in law to pick her up ‘after lunch. Mrs J needed medications to take away (TTAs), and needed her discharge paperwork completing, and her community nurse needed to be informed to attend her at home the following day. Nurse M had two other patients to discharge that day, and had to provide care for three other patients, two of whom had had surgery the previous day. Nurse M carried out the medication round in her bay at 8 am and at 2pm. At four pm Mrs Js daughter approached me to ask why her mother had not been discharged yet. She was considerably distressed, as her mothers stay in hospital had been much longer than anticipated. The perceived delay in her discharge had upset the patient and her family. Nurse M stated that she had started the discharge but been too busy to complete it during her shift. She therefore handed over the discharge to the afternoon shift nurse, Nurse F. Mrs J was discharged at 6pm. The next day, her daughter telephoned the ward to complain that Mrs J was discharged without her anti-hypertensive medication. The actions taken As the ward manager, I spoke to the patients daughter and apologised for the discharge taking so long, and for the failure to provide essential medication to take home. I spoke to Mrs J and to the community nurse, Nurse P, in order to ascertain whether there had been any adverse effects on the patients condition. Mrs Js daughter had visited the GP the following morning and obtained a replacement prescription, and so Mrs J missed only one dose, and one delayed dose of her antihypertensive medication. No adverse impact had been identified. Following this incident, I reviewed the case notes of Mrs J, and all the patients in B Bay on Ward X, to ensure that there had been no other oversights or omissions. I reviewed the discharge documentation for the second patient discharged that day, Miss T, and found that all was in order. A review of the discharge notes for Mrs J showed that the TTA prescription had not included the antihypertensive medication. The staff involved Nurse M, a Band 5 nurse with 3 years experience. Nurse F, a Band 5 nurse who joined the ward 3 months previously. The ward manager, a Band 7 nurse. Nursing Assistant L, a trained HCA with eight years experience on this ward. The patients involved Mrs J, a patient recovery from healthcare associated pneumonia after a laparascopic cholecystecomy. Five other patients in B Bay on Ward X: Mrs T, Miss S, Mrs L, and Ms K. Other important aspects and considerations that you consider necessary The ward was full that day, and there was one member of staff missing for part of the morning shift, due to sickness. The omission in the medication order can be localised to the Senior House Officer who signed the TTA request, but Nurse M should also have identified that the medication was missing, either at the time of completing the form. Nurse F should have identified the omission when she checked the medication with the patient at the time of discharge. Both nurses were questioned and given a verbal reprimand. B) Essay As a ward manager, observing the behaviours of staff working together within a ward team, I have often noticed that the discharges which are ordered at the time of the ward round early in the morning are often not completed until the evening, even when the discharge is relatively uncomplicated. I have also noticed that this reflects other aspects of care, where staff do not seem to be working particularly quickly or efficiently. In this situation, the behaviours of staff seemed to indicate on first analysis that staff were overworked and that this omission occurred because of pressure on staff. However, this author also identified other issues which were contributing to the situation. The first was that I noticed how staff had fallen into particular behavioural patterns during the early shift, which meant that they often left discharges to be completed by the afternoon staff. It seemed that certain staff tended to fall into this pattern, and to fall into particular routines in which they slowed down at certain times during the shift. I noted as well that there were a particular sub group of nursing staff that behaved like this, and that there was a divide between some staff and those who supported them, such as the HCAs. For example, Nurse M and HCA L did not seem to work well together, and I noted that Nurse M had addressed this by simply not delegating too much to the HCA. This situation seems to indicate that not only is good management and leadership needed in order to address what seems to be an issue of staff behaviours, but also good leadership in relation to team working, warranting an analysis and examination of team working. It became apparent that as the ward manager I would need to use the position of team leader to destabilise the ingrained patterns of work behaviour and break up old alliances which might be impeding effective teamworking. The conclusion reached was that this was not simply a case of finding fault with Nurse M and Nurse F, but deconstructing the circumstances that had led to this mistake. The fault in this situation is diffused amongst all of those involved. This included a potential that it was my own leadership at fault in this situation, requiring me to bear some of the responsibility for this occurrence. Leadership within nursing requires a complex set of skills and attributes, and the ability to manifest a strong nursing leadership role. However, it is challenging because of the nature of the work, which can change rapidly at any point in time, and the nature of staff relationships and behaviours, which can involve complex interactions and inter-dependencies. Fostering effective teamworking in this situation, and leading a team towards better ways of working, is likely to be very challenging even when circumstances are good, but in a position where the team is one staff member short, it could be argued that this makes it all the more challenging. A manager needs to understand the whole theory and practice of teamworking within organisational contexts, and also understand how they can, in their own leadership role, support effective team working and improve care standards, whilst at the same time supporting staff dealing with a heavy and complex workload. All nurses must manage themselves and their own workloads, and must develop self-awareness of their own traits, strengths and developmental needs. This author has spent some time reflecting on their own capabilities, and has identified their own strengths, such as the ability to carry out routine tasks swiftly, and to prioritise care and workloads for better patient care and more efficient management of tasks and demands. Another personal strength is the ability to take a wider view and to consider a range of factors affecting workload, and team working, including skill mix and different personalities and how well staff work together. The academic field of organisational studies has long been concerned with leadership, theoretically and practically. It is a multifaceted concept and has been considered from a variety of perspectives, including an applied perspective with specific reference to nursing. There tends to be a polarisation of theoretical perspectives, in which some believe that some people are destined to be leaders because of pre-existing or innate abilities or proclivities, traits which make them ‘natural leaders; and some theorists posit that leadership is comprised of a set of skills and applied knowledge that can be acquired and used by anyone trained in them (Day, 2000, p 5810.) Thus some would argue that the people possessing ‘natural leadership skills and abilities would be the best leaders, while others continue to assert that there is no difference and that a person given the right training and development could be a good leader (Green, 2003, p 27). There is merit in both perspectiv es, in that a natural leader who has had training could be argued to be potentially better than one who has no predisposition to leadership, and that there may be some people who are not suited to leadership roles who should not aspire to be leaders. However, suggesting that leadership is something which can be learned is a much more egalitarian viewpoint, which could be positive, but could result in people being placed in positions of ‘official leadership against their own preference, when their true strengths lie elsewhere. In relation to the situation described in the report in part A, this author would argue that not only did the team require more directive leadership at this time, but that such leadership should be visible, tangible, and strong enough to ‘lead the team towards more collaborative and supportive working practice (Bishop, 2009). The literature shows that clear lines of command are important, but clear, strong leadership is more than simply exercising control over people, it is a more bilateral approach which engages leader and team in managing work in such a way that it improves patient care (Clegg, 2000, p 31). However, Grint (2005, p 1467) also shows that in order for leaders to be effective, they must be able to motivate others to follow them and to go in the direction they have indicated. Thus leadership is more than simply guiding people, it is about engaging with them and making them ‘want to follow the lead. Thus it is possible to see that authority does not locate an individual as a leader on its own; the ‘followers must accept and support that leader as well (Grint, 2005 p 1467). In this case, however, the leadership activities must be very much directed at leading a diverse team of disparate individuals with a range of personalities, skills, and experience, as well as differing roles and responsibilities. Breakdowns in interprofessional working and communication are common within healthcare settings (Sutcliffe et al, 2004, p 196). However, organisational theories argue that there are typical types of roles that individuals assume within teams, and the seminal theory here is Belbins (1993 p 57) team roles theory. This theory is useful because it allows the leader to ‘manage individual team members and motivate the team more effectively through understanding their team roles (Belbin, 1993 p 57; Johansen, 2003, online). Anything which enhances team working is likely to improve communication, enhance team and individual worker efficiency and effectiveness, and improve nurses satisfaction with their working lives, contributing to better practice standards ( Amos et al, 2005 p 10; Clegg, 2000 p 31; Dimeglio, 2005 p 110), and this author would also argue that exploring how to manage a team more effectively would help them to contribute to their own professional development (Bandura, 1994 p 71). Thus, an effective leader could look at the eight defined roles which are said to occur within organisational or workplace teams, some of which may be fulfilled or enacted by more than one person at a time, just as one person may enact more than one role at once (Belbin, 1993 p 57-59). Effective teams ideally demonstrate that members enact all the roles defined (Johansen, 2003, 0nline). Belbin (1993 p 57-59) describes these as: the calm, confident chairman, objective but unemotional, generally infallible; the impatient shaper, coercive, unafraid of confrontation, directive and apt to destabilise the status quo; the problem-solving plant, an imaginative highly intellectual and creative individualist who may not be a good team player; the informativ e and enthusiastic resource investigator, good at communicating, who can find their motivation flagging; the analytical and evaluative monitor evaluator, who can be perceptive but cynical; the reliable company worker, who plods along and reaches goals but can display a degree of rigidity and inflexibility; the mediating team worker who tends to be both a communication hub and coordinator, using effective social skills to propel the team along; and the conscientious and deadline-conscious completer-finisher (Johansen, 2003, online). This author would argue, however, that the team leader could occupy one or more of these roles, but if they have a manager, may not be viewed by others to be a member of the team, per se, and so not included in the ‘inventory of team members. Thus there may be a flaw in this theory, because there is no specification of how a manager would necessarily fit in to this team. Team leadership in this context, however, is complicated by the nature of healthcare practice in which teams are comprised of multiple professionals and occupational groups (Cockburn, 2004 p 66), and thus a nurse manager of a ward has to be able to be a leader across different professions and disciplines and may need to display different leadership behaviours in order to achieve this (Murphy, 2005, p 128). One way in which a ward manager might lead in this manner is through quality management activities (Sale, 2005), and the use and promotion of evidence for practice, a process which requires multiprofessional input (McLaren et al, 2002 p 444). But in this case, the issues which have proved most challenging relate to the ways in which team members manage their workloads, and perhaps also the ways in which different professionals within the team communicate with each other. The manager must lead the team towards a new way of functioning effectively, by ensuring all members are functioning appropriately and fulfilling their different roles (Amos et al, 2005 p 10). This author would argue that within the greater quality agenda, the common goals of quality assurance should act as a common driving force for better teamworking (Martin, 2003). In this instance, the ward manager will be working to encourage better multidisciplinary team (McFadzean, 1998), but this does not mean that they have the authority to discipline some members of the team, such as the medical staff, and here, historical divides between the professions may impede the process of team building (Hartley, 2002, p 178). In this situation, Nurse M and Nurse F should both have felt able to ask for assistance if they were busy, and should have checked the TTA prescription, but the ultimate responsibility lies with the SHO who wrote the prescription. Legally, however, all are accountable. But the ward manager, as team leader, would lead by example by accepting the shared accountability of this omission (Sheldon and Parker, 1997, p 8). Thus the nurses should be supported to accept this shared responsibility, but at the same time should be supported to examine their practice and see where it could be improved, such as looking at how they could improve delegation skills so that basic tasks are more effectively delegated and advanced nursing responsibilities are better met (Curtis and Nichol, 2004, p 26), and how they can improve interprofessional communication (Kenny, 2002). This author would argue that nurses in the ward setting are all required to develop leadership skills, as an extension of their professional role, and this equates to the concept of distributed leadership (Harris and Spillane, 2008, p 31), and within this model, leaders are developed, supported and empowered, at every point on the scale of organisational hierarchy. Therefore, in this situation, the ward manager would need to understand who acts as what within the team roles inventory (Belbin, 1993), and also support leadership skills to emerge amongst staff at every level. The HCA described in this scenario, for example, exerts significant influence, and these leadership attributes could be harnessed to improve team working, rather than destabilise the hierarchy. The role of the manager as team leader in this scenario is clearly also to provide feedback and evaluation to the team, and to explore the consequences of these circumstances in a way that should prevent it from occurring again (London et al, 1999, p 5). Providing feedback in an empowering manner can improve performance within the team (London et al, 1999, p 5), and therefore, evidence from available research would suggest that effective leadership would achieve this through multiple approaches. Research suggests that optimal team performance and quality of care requires good leadership (Beech, 2002 p 35; Green, 2003 p 27). This seems to require what Murphy (2005 p 128), describes as charismatic, transformational leadership, in which â€Å"charismatic transformational leaders espouse intellectual stimulation and individual consideration to empower staff and enhance patient care. Nurse managers that develop and foster transformational leadership can surmount oppressive traditions and confidently navigate a complex and rapidly changing health care environment.† However, leaders such as this will continue to struggle with the hierarchies and inherited culture and traditions of the professions (Murphy 2005 p 128). But it is through such activities that proactive nurse leaders mould the future of nursing itself, and contribute significantly to the quality agenda (Shirey, 2006, p 256). Thus the leader in this scenario needs to re-educate the team, and act as a role model fo r the team to develop their own leadership capabilities (Cummings et al, 2008, p 240). It would appear that in this situation, the risk involved was avoided by luck rather than judgement, and it is imperative that the ward manager addresses the behaviours and habits which have led to the omission concerned. However, it would not be enough to simply discipline those concerned, because multiple factors have affected this occurrence, and the staff involved will have to continue to deal with these factors in the daily working lives. Therefore, leadership will lead, guide and empower staff to be able to better address their work roles whilst managing the competing demands on their time and attention, through better self management, better communication, better team working, and with clear, motivational guidance from a true leader.

Underlying Trend Rate of Growth

Explain the term ‘underlying trend rate of growth’ and the factors determining this rate. The underlying trend rate of growth represents a curve which shows the annual potential growth maximum that can be achieved with all available resources. An economy must target to increase this rate of growth and also actualize it. If the economy grows higher than this rate it will experience inflation. If lower it still has the capacity to grow. The trend rate of growth for an economy also represents the aggregate supply in the long run. The production possibility frontier also represents virtually more or less the same thing.There are various factors that determine long run aggregate supply. One considerable factor is the level of investment in an economy. Investment is vital as it is the back bone of economy. It enhances an economy by building more facilities and providing infrastructure to further develop and produce more, both in terms of quality and quantity. The higher the le vel of investment the higher the increase in capacity terms what an economy is able to produce. This is the growth that is in the nation’s stock of capital. New capital embodies technological advancements which leads to higher levels of productivity.The trend rate of growth is also determined by the trend growth of the working population of an economy. This is the trend of supply in the labour market. When the size of the working population increases it increases the potential working capacity of the economy. The magnitude of change in production output will reflect upon the level of labour/capital intensiveness in the economy. If the government can successfully increase the number of people of working age the trend rate of growth will increase. The trend rate of growth of factor productivity is a measure of gains in factor efficiency.For most countries it is the annual rate of growth of productivity that drives the long-term rate of economic growth. But of more interest and importance is where gains in productivity come from. The macroeconomic data on productivity is simply the aggregation of productivity performance at a microeconomic level throughout every industry and market in the economy. Technological improvements which reduce the real costs of supplying goods and services and which lead to an outward shift in a country’s production possibility frontier

General Overview of Gats

1. General overview of GATS The General Agreement on Trade in Services (GATS) is the first and only set of multilateral rules covering international trade in services. The definition of services trade under the GATS is four-pronged, depending on the territorial presence of the supplier and the consumer at the time of the transaction. The GATS covers services supplied a. Cross border trade: from the territory of one Member into the territory of any other Member. . Consumption abroad: in the territory of one Member to the service consumer of any other Member. c. Commercial presence: by a service supplier of one Member, through commercial presence, in the territory of any other Member. d. Presence of natural persons: by a service supplier of one Member, through the presence of natural persons of a Member in the territory of any other Member. 2. Proposed benefits of GATS There are six benefits of GATS, they are 1.Economic performance, An efficient services infrastructure is a preconditio n for economic success, many governments rely on an open and transparent environment for the provision of services. 2. Development, World-class enterprises in developing countries have a greater advantage, and better do business. Developing countries also have able to build on foreign investment and expertise 3. Consumer savings, Globalization of trade in services allows consumers a wider choice of lower prices, better quality goods and services 4.Faster innovation, The exchanges between the countries, information can promote technology innovation faster. 5. Greater transparency and predictability, Legally binding guarantee, allows companies in the international trade and investment in a stable condition. 6. Technology transfer, encourage foreign direct investment (FDI) usually can bring new skills and techniques. 3. Major criticisms of GATSMany civic groups said that most of the current economic restructuring under the WTO-OMC system is in the interest of big business, and not in t he interest of the public. They are concerned that further deregulation of the service sector will lead to a widening of the gap between rich and poor, to further environmental deterioration, and human cost is low in poor areas. 4. My opinion on GATS Overall, GATS met with some difficulties in the actual operation, and has created the problem of some criticism for people, but the trade agreements made n indelible contribution to the development of international trade in the world. As long as the various countries, the company is in the future economic and trade constantly looking for better solutions to improve the existing mechanism, the world economy is definitely better services under the framework of GATS rapid development. http://www. wto. org/english/tratop_e/serv_e/cbt_course_e/intro1_e. htm http://www. wto. org/english/tratop_e/serv_e/gats_factfiction3_e. htm http://www. twnside. org. sg

Career Goals My Career Goal - 905 Words

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The Tragedy of Sexual Molestation of a Child Essay

Imagine yourself as a child. More specifically, a young boy. Life as a child seems simple enough. While you are young you have care givers who try to make sure that everything is done for you. But there is still the matter of growing up. When you are young, adults cherish your innocence. Everyone just wants to protect you from the dangers of the world. You are a symbol of hope, with the whole world ahead of you. What if the innocence that all of your loved ones cherish, no longer exists? All the â€Å"cute† â€Å"corky† things you did was just acting, in a feeble attempt to bring back the child you once were. Something so precious was taken from you, and all you can think of doing is blaming yourself. The guilt consumes you the more you†¦show more content†¦Even with all these numbers and many more within the other resources of information, there is still a lot unknown due to how difficult this issue is to keep tabs on. 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Should Human Reproductive Cloning Be Legal Essay - 834 Words

The matter of human reproductive cloning is a complex topic, in which there are many issues that must be addressed before any actions take place. Any decision based on reproductive cloning will not be clear-cut, and instead will host a multitude of ideas. In this paper, I will determine, through philosophical thinking, if human reproductive cloning is morally appropriate. First and foremost, it is important to discuss what human cloning is. It is the conception of in vitro embryos that produces â€Å"individuals that are exact genetic copies of the donor from whom the DNA was obtained† (Munson 366). In Laymen’s terms, cells are inserted from the donor host into an unfertilized egg from another host (meaning it is asexual) and the new egg is†¦show more content†¦This theory is applicable to the topic because it is based on doing our moral duty, no matter what our own desires entail. Our tools in determining the correct action to do are universality and respect for others. Therefore, any solution of our problems must stem from these necessities. We are hence in search of the â€Å"maxims that satisfy the categorical imperative†, or the â€Å"motive force behind our actions †¦that determines [our] moral character† (Munson 872). Initially, we must consider the major possible courses of action. The first possibility is that human cloning is allowed. Scientists test experiments freely without constraints from the government. To analyze this in the views of Kantianism, we must apply â€Å"universalizability† or the idea that we must act consistently and apply a moral maxim to all similar cases (Munson 871). By applying this idea, we now cannot allow this first course of action to take place. By allowing any sort of experimentation to exist would lead to high probability of birth defects and can also cause great detriment to the surrogate mother, as discussed above. It simply cannot be morally permissible to allow this freelance kind of research to occur without monitoring, as the act of implanting an embryo can be perilous within itself, and is bound to harm someone. By causing harm to a person, we are then causing the person to suffer. Causing a person to suffer goesShow MoreRelatedWhy Is Cloning? Livin g A Wonderful Life?1668 Words   |  7 PagesWhy Cloning? Imagine living a wonderful life. A life full of friends and loving relationships. A healthy life. Celebrating holidays with friends and families and finally starting to fall in love with the person might†. Then all of a sudden your wonderful life comes to a screeching halt when you go to the doctor and is diagnosed with HIV, a fatal disease with no cure. You’re now faced with countless decisions such as whether or not you want to be heavily medicated. More medications could lead toRead MoreLiving A Wonderful Life : A Life Full Of Friends And Loving Relationships1666 Words   |  7 Pagesup. 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Solutions to end this horrendous procedure is to enforce reproductive cloning to be prohibited throughout countries/continentsRead MoreHuman Cloning- Term Paper1562 Words   |  7 PagesShould human reproductive cloning be accepted? Based from Human Genome Project Information (n.d.), à ¢Ã¢â€š ¬Ã…“Cloning is a term traditionally used by scientists to describe different processes for duplicating biological material.à ¢Ã¢â€š ¬Ã‚  It means creating a genetically identical copy of an organism. Scientists attempted to clone animals for many years. In fact, there are hundreds of cloned animals existing today. It started in 1952 when a tadpole was cloned. But worldwide attention and concerns only arousedRead MoreHuman Cloning- Term Paper1576 Words   |  7 PagesShould human reproductive cloning be accepted? 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The use of human embryos in research goes beyond an ethical issue and covers legal and social issuesRead More Reproductive and Therapeutic Cloning Essay example1484 Words   |  6 PagesReproductive and Therapeutic Cloning Cloning is defined as the â€Å"creation of an exact copy of a living matter, such as a cell or organism† according to Encarta encyclopedia. The copies produced through cloning have identical genetic makeup and are known as clones. Scientists use cloning techniques in the laboratory to create copies of cells or organisms with valuable traits. Cloning is a controversial topic because new areas of science often raise questions about safety. Early experiment

A Streetcar Named Desire Scene Analysis free essay sample

Stella tries to explain to Balance her relationship with Stanley at the beginning of scene 4 and mentions that she was Colors of thrilled by his violence. I think by this she means that she is quite taken in by Stanley display of annalistic behavior because it is so different from the type of environment in which she was brought up in. I believe that she tolerates all of Stanley behavior because for her it seems unique as she would never have been permitted to behave in the way that Stanley does when she was a child.In this situation, opposites really do seem to attract one another which is precisely why Stella is attracted to Stanley. 2) The scene directions at the beginning of scene 4 clearly show the basis for Stella and Stanley relationship: SEX. Sex with Stanley has an almost mystical effect on Stella. It seems that Stella Is quite happy In her own reality once satisfying her desire. We will write a custom essay sample on A Streetcar Named Desire Scene Analysis or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Her face Is described as serene, and her eyes and lips have that almost anarchized tranquility that Is In the faces of Eastern Idols. Stalls comment that there are things that happen between a man and a woman in the darkest sort of make everything else seem;unimportant, also emphasizes her purely physical relationship with Stanley. 3) Balance mentions her and Stalls life in Belle Revere and tells Stella that she cant have forgotten that much of our bringing up. Obviously Balance believes that Stanley and Stalls current life is quite a contrast to what she and Stella should be used to.She contrasts Stanley with the refined men whom they both used to date and asks Stella rhetorically If she thinks there Is any part of a gentleman In his nature. Obviously Stella cant reply In the positive because of Stanley recent show f annalistic behavior. Balance also mentions the place In where Stella lives; she calls the street car that brought her there a rattle-trap street car that bangs through the Quarter, up one old narrow street.It is very apparent that the world of Belle Revere and the world in which Stella lives now is e xtremely different because of the difference in men, their behavior and even the place which seems very inferior when compared with Belle Revere. 4) I think the sound of the locomotive is there when he enters because it prevents the women from hearing that Stanley has entered. Balance is unlikely to have spoken so plainly about Stanley to Stella if she had known he was there.The stage directions even reinforce this; they state that Stanley enters under cover of the trains noise. Stanley doesnt go Into the room immediately because If he did then Stella and Balance would know that he was there and Stanley Is probably Interested In Blanches view of him and wants to listen. And when he grins through the curtains at Balance, I believe that he is trying to convey (non-verbally) to Balance that he knows that she dislikes him and that he replicates her feelings entirely.Or it could be possible that he knows things about Balance and is waiting for the opportune moment to reveal them to Stella. 6) I think that the music of the blue piano expresses the spirit of life in the city. It seems to represent the moods in the play. The music is first heard in scene 1, and is repeated whenever Balance remembers her dead husband or whenever there is a significant point in a scene. I think it is significant in scene 4 because Stanley finds out exactly what Balance thinks of him and he realizes that his feelings of hatred towards her are clearly Justified.